1
|
Bammert P, Schüttig W, Novelli A, Iashchenko I, Spallek J, Blume M, Diehl K, Moor I, Dragano N, Sundmacher L. The role of mesolevel characteristics of the health care system and socioeconomic factors on health care use - results of a scoping review. Int J Equity Health 2024; 23:37. [PMID: 38395914 PMCID: PMC10885500 DOI: 10.1186/s12939-024-02122-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 02/04/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Besides macrolevel characteristics of a health care system, mesolevel access characteristics can exert influence on socioeconomic inequalities in healthcare use. These reflect access to healthcare, which is shaped on a smaller scale than the national level, by the institutions and establishments of a health system that individuals interact with on a regular basis. This scoping review maps the existing evidence about the influence of mesolevel access characteristics and socioeconomic position on healthcare use. Furthermore, it summarizes the evidence on the interaction between mesolevel access characteristics and socioeconomic inequalities in healthcare use. METHODS We used the databases MEDLINE (PubMed), Web of Science, Scopus, and PsycINFO and followed the 'Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols extension for scoping reviews (PRISMA-ScR)' recommendations. The included quantitative studies used a measure of socioeconomic position, a mesolevel access characteristic, and a measure of individual healthcare utilisation. Studies published between 2000 and 2020 in high income countries were considered. RESULTS Of the 9501 potentially eligible manuscripts, 158 studies were included after a two-stage screening process. The included studies contained a wide spectrum of outcomes and were thus summarised to the overarching categories: use of preventive services, use of curative services, and potentially avoidable service use. Exemplary outcomes were screening uptake, physician visits and avoidable hospitalisations. Access variables included healthcare system characteristics such as physician density or distance to physician. The effects of socioeconomic position on healthcare use as well as of mesolevel access characteristics were investigated by most studies. The results show that socioeconomic and access factors play a crucial role in healthcare use. However, the interaction between socioeconomic position and mesolevel access characteristics is addressed in only few studies. CONCLUSIONS Socioeconomic position and mesolevel access characteristics are important when examining variation in healthcare use. Additionally, studies provide initial evidence that moderation effects exist between the two factors, although research on this topic is sparse. Further research is needed to investigate whether adapting access characteristics at the mesolevel can reduce socioeconomic inequity in health care use.
Collapse
Affiliation(s)
- Philip Bammert
- Chair of Health Economics, Technical University of Munich, Munich, Germany.
| | - Wiebke Schüttig
- Chair of Health Economics, Technical University of Munich, Munich, Germany
| | - Anna Novelli
- Chair of Health Economics, Technical University of Munich, Munich, Germany
| | - Iryna Iashchenko
- Chair of Health Economics, Technical University of Munich, Munich, Germany
| | - Jacob Spallek
- Department of Public Health, Brandenburg University of Technology Cottbus-Senftenberg, Senftenberg, Germany
- Lausitz Center for Digital Public Health, Brandenburg University of Technology, Senftenberg, Germany
| | - Miriam Blume
- Department of Epidemiology and Health Monitoring, Robert-Koch-Institute, Berlin, Germany
| | - Katharina Diehl
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Irene Moor
- Institute of Medical Sociology, Interdisciplinary Center for Health Sciences, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Nico Dragano
- Institute of Medical Sociology, Centre for Health and Society, University Hospital and Medical Faculty, University of Duesseldorf, Duesseldorf, Germany
| | - Leonie Sundmacher
- Chair of Health Economics, Technical University of Munich, Munich, Germany
| |
Collapse
|
2
|
Stavre Z, Kim JM, Yang YS, Nündel K, Chaugule S, Sato T, Park K, Gao G, Gravallese E, Shim JH. Schnurri-3 inhibition suppresses bone and joint damage in models of rheumatoid arthritis. Proc Natl Acad Sci U S A 2023; 120:e2218019120. [PMID: 37141171 PMCID: PMC10175794 DOI: 10.1073/pnas.2218019120] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 03/10/2023] [Indexed: 05/05/2023] Open
Abstract
Rheumatoid arthritis (RA) is a chronic inflammatory disease that leads to systemic and articular bone loss by activating bone resorption and suppressing bone formation. Despite current therapeutic agents, inflammation-induced bone loss in RA continues to be a significant clinical problem due to joint deformity and lack of articular and systemic bone repair. Here, we identify the suppressor of bone formation, Schnurri-3 (SHN3), as a potential target to prevent bone loss in RA. SHN3 expression in osteoblast-lineage cells is induced by proinflammatory cytokines. Germline deletion or conditional deletion of Shn3 in osteoblasts limits articular bone erosion and systemic bone loss in mouse models of RA. Similarly, silencing of SHN3 expression in these RA models using systemic delivery of a bone-targeting recombinant adenoassociated virus protects against inflammation-induced bone loss. In osteoblasts, TNF activates SHN3 via ERK MAPK-mediated phosphorylation and, in turn, phosphorylated SHN3 inhibits WNT/β-catenin signaling and up-regulates RANKL expression. Accordingly, knock-in of a mutation in Shn3 that fails to bind ERK MAPK promotes bone formation in mice overexpressing human TNF due to augmented WNT/β-catenin signaling. Remarkably, Shn3-deficient osteoblasts are not only resistant to TNF-induced suppression of osteogenesis, but also down-regulate osteoclast development. Collectively, these findings demonstrate SHN3 inhibition as a promising approach to limit bone loss and promote bone repair in RA.
Collapse
Affiliation(s)
- Zheni Stavre
- Department of Medicine, Division of Rheumatology, University of Massachusetts Chan Medical School, Worcester, MA01605
| | - Jung-Min Kim
- Department of Medicine, Division of Rheumatology, University of Massachusetts Chan Medical School, Worcester, MA01605
| | - Yeon-Suk Yang
- Department of Medicine, Division of Rheumatology, University of Massachusetts Chan Medical School, Worcester, MA01605
| | - Kerstin Nündel
- Department of Medicine, Division of Rheumatology, University of Massachusetts Chan Medical School, Worcester, MA01605
| | - Sachin Chaugule
- Department of Medicine, Division of Rheumatology, University of Massachusetts Chan Medical School, Worcester, MA01605
| | - Tadatoshi Sato
- Department of Medicine, Division of Rheumatology, University of Massachusetts Chan Medical School, Worcester, MA01605
- Horae Gene Therapy Center, University of Massachusetts Chan Medical School, Worcester, MA01605
- Li Weibo Institute for Rare Diseases Research, University of Massachusetts Chan Medical School, Worcester, MA01605
- Endocrine Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA02114
| | - Kwang Hwan Park
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul03722, South Korea
| | - Guangping Gao
- Horae Gene Therapy Center, University of Massachusetts Chan Medical School, Worcester, MA01605
- Li Weibo Institute for Rare Diseases Research, University of Massachusetts Chan Medical School, Worcester, MA01605
- Department of Microbiology and Physiological Systems, University of Massachusetts Chan Medical School, Worcester, MA01605
- Viral Vector Core, University of Massachusetts Chan Medical School, Worcester, MA01605
| | - Ellen M. Gravallese
- Department of Medicine, Division of Rheumatology, Inflammation and Immunity, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA02115
| | - Jae-Hyuck Shim
- Department of Medicine, Division of Rheumatology, University of Massachusetts Chan Medical School, Worcester, MA01605
- Horae Gene Therapy Center, University of Massachusetts Chan Medical School, Worcester, MA01605
- Li Weibo Institute for Rare Diseases Research, University of Massachusetts Chan Medical School, Worcester, MA01605
| |
Collapse
|
3
|
[Gender-specific differences in the diagnosis and treatment of inflammatory rheumatic diseases]. INNERE MEDIZIN (HEIDELBERG, GERMANY) 2023:10.1007/s00108-023-01484-3. [PMID: 36877237 PMCID: PMC10366264 DOI: 10.1007/s00108-023-01484-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/26/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND Gender differences in the diagnosis and treatment of various diseases are increasingly being researched with the aim of optimizing treatment strategies and improving individual treatment success. METHODS This paper summarizes the existing literature for gender differences in inflammatory rheumatic diseases. RESULTS Many, but not all, inflammatory rheumatic diseases occur more frequently in women than in men. Women more often have a longer duration of symptoms until diagnosis than men, which may be due to different clinical and radiological presentations. Across diseases, women more often have lower remission and treatment response rates to antirheumatic medication compared to men. Discontinuation rates are also higher in women than in men. Whether women are more likely to develop anti-drug antibodies to biologic disease-modifying antirheumatic drugs is still unclear. For Janus kinase inhibitors, there is no evidence of differential treatment response to date. CONCLUSION Whether individual dosing regimens and gender-adapted remission criteria are also required in rheumatology cannot be deduced from the evidence available to date.
Collapse
|
4
|
Saraiva L, Duarte C. Barriers to the Diagnosis of Early Inflammatory Arthritis: A Literature Review. Open Access Rheumatol 2023; 15:11-22. [PMID: 36733437 PMCID: PMC9888401 DOI: 10.2147/oarrr.s282622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 01/17/2023] [Indexed: 01/28/2023] Open
Abstract
The early identification of patients with inflammatory arthritis and their referral to rheumatologists in order to establish a diagnosis and to start treatment plays a crucial role in patient outcomes. However, it is recognized that a large proportion of patients with inflammatory arthritis are diagnosed very late, losing the opportunity to start treatment in the very early stages of disease, resulting in a worse prognosis. This delay depends on several factors related to the patient, the disease, socio-demographic and health system aspects. Over time, several strategies have been developed and implemented at different levels aiming to overcome such barriers and to reduce the time from the onset of the symptoms until the diagnosis and start of adequate treatment. In this non-systematic comprehensive review, we will describe the main barriers in the identification of patients with inflammatory arthritis at different levels. We will also discuss the different strategies that have been implemented with the objective to overcome the recognized barriers and their impact in the reduction of delays.
Collapse
Affiliation(s)
- Liliana Saraiva
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Catia Duarte
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal,iCBR, Faculdade de Medicina, Universidade de Coimbra, Coimbra, Portugal,Correspondence: Catia Duarte, Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Praceta Mota Pinto, Coimbra, 3000-004, Portugal, Tel +351 960330278, Email
| |
Collapse
|
5
|
Santos-Moreno P, Rodríguez-Vargas GS, Martínez S, Ibatá L, Villarreal-Peralta L, Aza-Cañon A, Rivero M, Rodriguez P, Rojas-Villarraga A. Better Clinical Results in Rheumatoid Arthritis Patients Treated Under a Multidisciplinary Care Model When Compared with a National Rheumatoid Arthritis Registry. OPEN ACCESS RHEUMATOLOGY: RESEARCH AND REVIEWS 2022; 14:269-280. [PMID: 36426199 PMCID: PMC9680987 DOI: 10.2147/oarrr.s385423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 11/04/2022] [Indexed: 11/19/2022]
Abstract
Purpose To describe clinical characteristics and effectiveness of health care in patients with rheumatoid arthritis (RA) as part of a multidisciplinary care model (MCM) in a specialized rheumatology center, compared with the results of a national registry of RA (NARRA) as evidence of real-world management. Patients and Methods We conducted a real-world study (July 1, 2018 to June 30, 2019) based on an analysis of electronic health records of a cohort of RA patients managed with the “Treat-to-Target” strategy in a specialized rheumatology center in Colombia with an MCM, compared with the NARRA that includes different models of usual care. Results We have analyzed 7053 subjects with RA treated at a specialized rheumatology center and 81,492 patients from the NARRA. Cohorts were similar in their baseline characteristics, with women in predominance and diagnosis age close to 50 years. At the time of diagnosis, a higher proportion of clinical diagnostic test use and rheumatology consultation access was observed in the specialized rheumatology center than in the national registry (4–6 per year versus three or less). In addition, higher proportions of patients in remission and low disease activity were reported for the specialized rheumatology center, with a >40% amount of data lost in the national registry. Pharmacological management was similar regarding the analgesic use. In the specialized center, Certolizumab was more frequently used than in the NARRA registry; also, there were significant differences in methotrexate, leflunomide, and sulfasalazine use, being higher in the specialized rheumatology center. Conclusion The MCM of a specialized center in RA can guarantee comprehensive care, with better access to all the services required to manage the disease. It ensures specialist management and evidence-based care that facilitates the achievement of therapeutic objectives. In addition, better patient records and follow-ups are available to evaluate health outcomes.
Collapse
Affiliation(s)
- Pedro Santos-Moreno
- Rheumatology Department, Biomab IPS, Bogotá, Colombia
- Correspondence: Pedro Santos-Moreno, Rheumatology Department, Biomab IPS, Calle 48 # 13-86, Bogotá, Colombia, Tel +57 320 8094232, Email
| | | | - Susan Martínez
- Epidemiology Department, Epithink Health Consulting, Bogotá, Colombia
| | - Linda Ibatá
- Epidemiology Department, Epithink Health Consulting, Bogotá, Colombia
| | | | | | - Manuel Rivero
- Rheumatology Department, Biomab IPS, Bogotá, Colombia
| | | | | |
Collapse
|
6
|
Abstract
Psoriatic arthritis (PsA) is an inflammatory musculoskeletal disease with a chronic, progressive course. Various aspects of PsA, including its clinical features, disease course and response to treatment, are influenced by sociodemographic characteristics of the patient. This includes patient sex, the biological attributes associated with being male or female, and gender, a sociocultural construct that comprises attitudes, traits and behaviours associated with being a man or a woman. An understanding of sex- and gender-related differences in PsA, as well as their underlying mechanisms, is therefore important for individualized care. In this narrative review, the influence of sex and gender on PsA manifestation and course, patient function and quality of life, and their association with comorbidities are described. Sex- and gender-related disparities in response to advanced therapies and their potential underlying mechanisms are delineated. Differences in pathophysiological mechanisms between male and female patients including genetics, immune and hormonal mechanisms are discussed. Finally, fertility and pregnancy outcomes in PsA are outlined. By adopting sex and gender lenses, this review is aimed at highlighting key differences between male and female patients with PsA and uncovering mechanisms underlying these differences, ultimately promoting individualized care of men and women with PsA and informing future research in this area.
Collapse
|
7
|
Barber CEH, Lacaille D, Croxford R, Barnabe C, Marshall DA, Abrahamowicz M, Xie H, Avina-Zubieta JA, Esdaile JM, Hazlewood G, Faris P, Katz S, MacMullan P, Mosher D, Widdifield J. A Population-Based Study Evaluating Retention in Rheumatology Care Among Patients With Rheumatoid Arthritis. ACR Open Rheumatol 2022; 4:613-622. [PMID: 35514156 PMCID: PMC9274367 DOI: 10.1002/acr2.11442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/22/2022] [Accepted: 03/28/2022] [Indexed: 12/03/2022] Open
Abstract
Objective The study objective was to assess adherence to system‐level performance measures measuring retention in rheumatology care and disease modifying anti‐rheumatic drug (DMARD) treatment in rheumatoid arthritis (RA). Methods We used a validated health administrative data case definition to identify individuals with RA in Ontario, Canada, between 2002 and 2014 who had at least 5 years of potential follow‐up prior to 2019. During the first 5 years following diagnosis, we assessed whether patients were seen by a rheumatologist yearly and the proportion dispensed a DMARD yearly (in those aged ≥66 for whom medication data were available). Multivariable logistic regression analyses were used to estimate the odds of remaining under rheumatologist care. Results The cohort included 50,883 patients with RA (26.1% aged 66 years and older). Over half (57.7%) saw a rheumatologist yearly in all 5 years of follow‐up. Sharp declines in the percentage of patients with an annual visit were observed in each subsequent year after diagnosis, although a linear trend to improved retention in rheumatology care was seen over the study period (P < 0.0001). For individuals aged 66 years or older (n = 13,293), 82.1% under rheumatologist care during all 5 years after diagnosis were dispensed a DMARD annually compared with 31.0% of those not retained under rheumatology care. Older age, male sex, lower socioeconomic status, higher comorbidity score, and having an older rheumatologist decreased the odds of remaining under rheumatology care. Conclusion System‐level improvement initiatives should focus on maintaining ongoing access to rheumatology specialty care. Further investigation into causes of loss to rheumatology follow‐up is needed.
Collapse
Affiliation(s)
- Claire E H Barber
- University of Calgary, Calgary, Alberta, Canada, and Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Diane Lacaille
- Arthritis Research Canada and University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Cheryl Barnabe
- University of Calgary, Calgary, Alberta, Canada, and Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Deborah A Marshall
- University of Calgary, Calgary, Alberta, Canada, and Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Michal Abrahamowicz
- Arthritis Research Canada, Vancouver, British Columbia, Canada, and McGill University, Montreal, Quebec, Canada
| | - Hui Xie
- Arthritis Research Canada, Vancouver British Columbia, Canada, and Simon Fraser University, Burnaby, British Columbia, Canada
| | - J Antonio Avina-Zubieta
- Arthritis Research Canada and University of British Columbia, Vancouver, British Columbia, Canada
| | - John M Esdaile
- Arthritis Research Canada and University of British Columbia, Vancouver, British Columbia, Canada
| | - Glen Hazlewood
- University of Calgary, Calgary, Alberta, Canada, and Arthritis Research Canada, Vancouver, British Columbia, Canada
| | | | - Steven Katz
- University of Alberta, Edmonton, Alberta, Canada
| | | | | | - Jessica Widdifield
- ICES, University of Toronto, and Sunnybrook Research Institute, Holland Bone and Joint Research Program, Toronto, Canada
| |
Collapse
|
8
|
Orozco T, Feldman DE, Bernatsky S, Légaré J, Perreault K, Tawiah AK, Zummer M, Hudon A. Evaluating a new referral pathway from physical therapists to rheumatologists: A qualitative study. J Interprof Care 2022; 36:932-940. [DOI: 10.1080/13561820.2022.2044295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Tatiana Orozco
- École de réadaptation, Faculté de Médecine, Université de Montréal, Montreal, QC, Canada
| | - Debbie Ehrmann Feldman
- School of Rehabilitation, Physiotherapy Program and School of Public Health, Department of Social and Preventive Medicine, Université de Montréal, Centre for Interdisciplinary Research in Rehabilitation, Institute of Public Health Research, Université de Montréal, Montreal, QC, Canada
| | - Sasha Bernatsky
- McGill University division of Rheumatology and Clinical Epidemiology, McGill University Health Centre, Montreal, QC, Canada
| | - Jean Légaré
- Patient Partner Member of Pira, Chu de Québec Université Laval, Arthritis Research, Canada
| | - Kadija Perreault
- School of Rehabilitation, Université Laval; Center for Interdisciplinary Research in Rehabilitation and Social Integration, QC, Canada
| | | | - Michel Zummer
- Université de Montréal and Hôpital Maisonneuve Rosemont, QC, Canada
| | - Anne Hudon
- School of Rehabilitation, Université de Montréal, Centre for Interdisciplinary Research in Rehabilitation of Greater Montréal (Crir), Centre de Recherche En Éthique (Cré), Montreal, QC, Canada
| |
Collapse
|
9
|
Passalent L, Sundararajan K, Perruccio AV, Hawke C, Coyte PC, Bombardier C, Bloom JA, Haroon N, Inman RD, Rampersaud YR. Bridging the Gap between Symptom Onset and Diagnosis in Axial Spondyloarthritis. Arthritis Care Res (Hoboken) 2021; 74:997-1005. [PMID: 34268914 DOI: 10.1002/acr.24751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 07/13/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To evaluate a stratified screening process for early identification of axial spondyloarthritis (axSpA) considering: 1) wait times from primary care to rheumatology screen; 2) incremental precision and accuracy from primary care to rheumatology screen; and 3) diagnostic delay. METHODS Adults with low back pain (LBP) attending primary care LBP clinics prospectively underwent a primary standardized clinical screen. Patients with LBP >3 months and onset age <50 years were referred for a comprehensive secondary screen by a physiotherapist with advanced rheumatology training. At secondary screening, patients with inflammatory features were deemed to have a low, medium, or high risk of axSpA vs. no risk. Precision and accuracy of this screening strata were measured against a rheumatologist with axSpA expertise. RESULTS In all, 405 patients underwent primary and secondary screening. Mean age was 36.9 years (±9.9); 55% were female. HLA-B27 was present in 14.4%. Median wait time from primary to secondary screen was 15 days. AxSpA risk assignment by rheumatologist was: 64.9% (none or low risk axSpA) and 35.1% (medium or high risk axSpA). The best combination of sensitivity (68%), specificity (90%), positive (80%) and negative (84%) predictive values was evident with the secondary screen. 15.6% of patients received a final diagnosis of axSpA. Median LBP duration from onset to diagnosis was: 2 years (non-radiographic axSpA) and 7 years (ankylosing spondylitis). CONCLUSION A stratified interprofessional screening process can facilitate rapid diagnosis of persistent LBP, with high precision and accuracy, in patients with axSpA.
Collapse
Affiliation(s)
- Laura Passalent
- Division of Rheumatology, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Kala Sundararajan
- Division of Orthopaedics, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network Toronto, Toronto, Canada
| | - Anthony V Perruccio
- Schroeder Arthritis Institute, Krembil Research Institute, Arthritis Community Research and Evaluation Unit, University Health Network, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Christopher Hawke
- Division of Orthopaedics, Schroeder Arthritis Institute, University Health Network, Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Peter C Coyte
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Claire Bombardier
- Toronto General Hospital Research Institute, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Jeff A Bloom
- Family and Community Medicine, University Health Network, Toronto, Canada
| | - Nigil Haroon
- Division of Rheumatology, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Robert D Inman
- Division of Rheumatology, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Departments of Medicine and Immunology, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Y Raja Rampersaud
- Division of Orthopaedics, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| |
Collapse
|
10
|
Ahluwalia V, Inrig T, Larsen T, Shupak R, Papneja T, Karasik A, Kennedy C, Lundon K. An Advanced Clinician Practitioner in Arthritis Care (ACPAC) Maintains a Positive Patient Experience While Increasing Capacity in Rheumatology Community Care. J Multidiscip Healthc 2021; 14:1299-1310. [PMID: 34113118 PMCID: PMC8184238 DOI: 10.2147/jmdh.s304206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 04/06/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose This study describes patient care experiences of solo-rheumatologist and co-managed care models utilizing an Advanced Clinician Practitioner in Arthritis Care-trained Extended Role Practitioner (ACPAC-ERP) in three community rheumatology practices. Materials and Methods Patients with inflammatory arthritis (IA) were assigned to care provided by one of three (2 senior, 1 early-career) community-based rheumatologists (usual care), or an ACPAC-ERP (co-managed care) for the 6-months following diagnosis. Patient experiences were surveyed using validated measures of patient satisfaction (Patient Doctor Interaction Scale-PDIS), global ratings of confidence and satisfaction, referral patterns, disease activity (RADAI) and self-perceived disability (HAQ-Disability) as well as demographic information. Practice capacity was evaluated 18-months prior to, and across, the study period. Results Of 55 participants (mean age 56.6 years, 61.8% female), 33 received co-managed care. Most participants were diagnosed with rheumatoid arthritis (65.5%) with a median symptom duration of 1.1 years. At 6-months, patients from both models of care were equally satisfied in terms of the information provided (usual care 4.6 vs co-managed care 4.7/5=greater satisfaction), rapport with health-care provider (4.6 vs 4.6/5) and having needs met (4.7 vs 4.5/5). Overall satisfaction was high (87.2 vs 85.3/100=completely satisfied) as was confidence in the system by which care was received (85.0 vs 82.1/100=completely confident). Usual care patients reported higher perceived disability than co-managed patients (HAQ-Disability 0.5 vs 0.2/3=unable to do). Significant differences in overall RADAI score (p=0.014) were found between the two models. The senior rheumatologist, with a previously saturated practice, attained a 37% capacity increase for new patients utilizing the co-managed care model. Conclusion The ACPAC-ERP model was equivalent to the solo-rheumatologist model with regard to patient experience and satisfaction. A co-management model utilizing a highly trained ACPAC-ERP can increase capacity in community rheumatology clinics for patients newly diagnosed with IA while maintaining confidence and satisfaction with their care.
Collapse
Affiliation(s)
- Vandana Ahluwalia
- Division of Rheumatology, Department of Internal Medicine, William Osler Health System, Brampton, ON, Canada
| | - Taucha Inrig
- Musculoskeletal Health and Outcomes Research, St. Michael's Hospital, Toronto, ON, Canada
| | - Tiffany Larsen
- Department of Physiotherapy, Headwaters Healthcare Centre, Orangeville, ON, Canada
| | - Rachel Shupak
- Division of Rheumatology, Department of Internal Medicine, St. Michael's Hospital, Toronto, ON, Canada
| | - Tripti Papneja
- Division of Rheumatology, Department of Internal Medicine, William Osler Health System, Brampton, ON, Canada
| | - Arthur Karasik
- Independent Rheumatology Practice, Etobicoke, ON, Canada
| | - Carol Kennedy
- Musculoskeletal Health and Outcomes Research, St. Michael's Hospital, Toronto, ON, Canada
| | - Katie Lundon
- Continuing Professional Development, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
11
|
Barber CEH, Marshall DA, Szefer E, Barnabe C, Shiff NJ, Bykerk V, Homik J, Thorne JC, Ahluwalia V, Benseler S, Mosher D, Twilt M, Lacaille D. A Population-Based Approach to Reporting System-Level Performance Measures for Rheumatoid Arthritis Care. Arthritis Care Res (Hoboken) 2021; 73:640-648. [PMID: 32144843 DOI: 10.1002/acr.24178] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 02/25/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To operationalize and report on nationally endorsed rheumatoid arthritis (RA) performance measures (PMs) using health administrative data for British Columbia (BC), Canada. METHODS All patients with RA in BC ages ≥18 years were identified between January 1, 1997 and December 31, 2009 using health administrative data and followed until December 2014. PMs tested include: the percentage of incident patients with ≥1 rheumatologist visit within 365 days; the percentage of prevalent patients with ≥1 rheumatologist visit per year; the percentage of prevalent patients dispensed disease-modifying antirheumatic drug (DMARD) therapy; and time from RA diagnosis to DMARD therapy. Measures were reported on patients seen by rheumatologists, and in the total population. RESULTS The cohort included 38,673 incident and 57,922 prevalent RA cases. The percentage of patients seen by a rheumatologist within 365 days increased over time (35% in 2000 to 65% in 2009), while the percentage of RA patients under the care of a rheumatologist seen yearly declined (79% in 2001 to 39% in 2014). The decline was due to decreasing visit rates with increasing follow-up time rather than calendar effect. The percentage of RA patients dispensed a DMARD was suboptimal over follow-up (37% in 2014) in the total population but higher (87%) in those under current rheumatologist care. The median time to DMARD in those seen by a rheumatologist improved from 49 days in 2000 to 23 days in 2009, with 34% receiving treatment within the 14-day benchmark. CONCLUSION This study describes the operationalization and reporting of national PMs using administrative data and identifies gaps in care to further examine and address.
Collapse
Affiliation(s)
- Claire E H Barber
- University of Calgary, Calgary, Alberta, Canada, and Arthritis Research Canada, Richmond, British Columbia, Canada
| | - Deborah A Marshall
- University of Calgary, Calgary, Alberta, Canada, and Arthritis Research Canada, Richmond, British Columbia, Canada
| | | | - Cheryl Barnabe
- University of Calgary, Calgary, Alberta, Canada, and Arthritis Research Canada, Richmond, British Columbia, Canada
| | | | - Vivian Bykerk
- Hospital for Special Surgery and Cornell University, New York, New York
| | - Joanne Homik
- University of Alberta, Edmonton, Alberta, Canada
| | | | | | - Susanne Benseler
- Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | | | - Marinka Twilt
- Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Diane Lacaille
- Arthritis Research Canada, Richmond, and University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
12
|
Keely E, Rostom K, Smith D, Liddy C. A comparison of faxed referrals and eConsult questions for rheumatology referrals: a descriptive study. CMAJ Open 2021; 9:E38-E43. [PMID: 33436454 PMCID: PMC7843073 DOI: 10.9778/cmajo.20200025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND In Canada, wait times for access to specialized rheumatology services have increased, leading to new strategies to improve timely care; electronic consultations (eConsults) enable providers to ask specialists a clinical question using a secure platform, often reducing the need for a face-to-face visit. In this study, we sought to compare the types of referrals received through fax versus eConsult and to determine whether faxed referrals could be addressed using eConsult. METHODS We conducted a descriptive study of consecutive faxed referrals sent to a tertiary care centre between Feb. 1 and Mar. 6, 2017, and a convenience sample of eConsults directed to rheumatology between Feb. 1, 2015, and Sept. 30, 2016, through the Champlain BASE eConsult Service, an Ontario-based service. We reviewed all referrals and categorized them by clinical content and question type. A rheumatologist with experience completing eConsult referrals assessed faxed referrals for their suitability to be answered through eConsults. Descriptive statistics were generated. RESULTS We analyzed 300 consecutive faxed referrals and 300 (of 470) eConsult referrals. Faxed questions more often pertained to rheumatoid arthritis (32/300 [10.7%] v. 17/300 [5.7%]), systemic lupus erythematosus (24/300 [8.0%] v. 10/300 [3.3%]), and polyarthritis (30/300 [10.0%] v. 18/300 [6.0%]). eConsults more often addressed abnormal serology without joint symptoms (27/300 [9.0%] v. 8/300 [2.7%]) and gout (15/300 [5.0%] v. 4/300 [1.3%]). Faxed referrals were more likely to have no specific question (116/300 [38.7%]), and eConsults were more likely to have more than 1 question posed (99/300 [33.0%]) and a drug-related question (67/300 [22.3%]). The rheumatologist identified potential benefit from eConsult in 216/300 (72.0%) faxed referrals and 55/59 (93.2%) declined faxed referrals. INTERPRETATION Despite differences in diagnosis between eConsults and faxed referrals, most faxed referrals showed the potential to be addressed through eConsult. Using eConsult may allow primary care providers to obtain answers to questions without requesting a face-to-face specialist referral, or provide support for patients awaiting face-to-face consultation.
Collapse
Affiliation(s)
- Erin Keely
- Department of Medicine (Keely, Smith), University of Ottawa; Department of Medicine (Keely, Smith) and Ontario eConsult Centre of Excellence (Keely, Liddy), The Ottawa Hospital; Department of Medicine (Rostom), Queensway Carleton Hospital; Department of Family Medicine (Liddy), C.T. Lamont Primary Health Care Research Centre, University of Ottawa; Bruyère Research Institute (Liddy), Ottawa, Ont.
| | - Krista Rostom
- Department of Medicine (Keely, Smith), University of Ottawa; Department of Medicine (Keely, Smith) and Ontario eConsult Centre of Excellence (Keely, Liddy), The Ottawa Hospital; Department of Medicine (Rostom), Queensway Carleton Hospital; Department of Family Medicine (Liddy), C.T. Lamont Primary Health Care Research Centre, University of Ottawa; Bruyère Research Institute (Liddy), Ottawa, Ont
| | - Douglas Smith
- Department of Medicine (Keely, Smith), University of Ottawa; Department of Medicine (Keely, Smith) and Ontario eConsult Centre of Excellence (Keely, Liddy), The Ottawa Hospital; Department of Medicine (Rostom), Queensway Carleton Hospital; Department of Family Medicine (Liddy), C.T. Lamont Primary Health Care Research Centre, University of Ottawa; Bruyère Research Institute (Liddy), Ottawa, Ont
| | - Clare Liddy
- Department of Medicine (Keely, Smith), University of Ottawa; Department of Medicine (Keely, Smith) and Ontario eConsult Centre of Excellence (Keely, Liddy), The Ottawa Hospital; Department of Medicine (Rostom), Queensway Carleton Hospital; Department of Family Medicine (Liddy), C.T. Lamont Primary Health Care Research Centre, University of Ottawa; Bruyère Research Institute (Liddy), Ottawa, Ont
| |
Collapse
|
13
|
Pianarosa E, Chomistek K, Hsiao R, Anwar S, Umaefulam V, Hazlewood G, Barnabe C. Global Rural and Remote Patients with Rheumatoid Arthritis: A Systematic Review. Arthritis Care Res (Hoboken) 2020; 74:598-606. [PMID: 33181001 PMCID: PMC9304257 DOI: 10.1002/acr.24513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 10/21/2020] [Accepted: 11/10/2020] [Indexed: 11/30/2022]
Abstract
Objective Rural and remote patients with rheumatoid arthritis (RA) are at risk for inequities in health outcomes based on differences in physical environments and health care access potential compared to urban populations. The aim of this systematic review was to synthesize epidemiology, clinical outcomes, and health service use reported for global populations with RA residing in rural and remote locations. Methods Medline, Embase, HealthStar, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and the Cochrane Library were searched from inception to June 2019 using librarian‐developed search terms for RA and rural and remote populations. Peer‐reviewed published manuscripts were included if they reported on epidemiologic, clinical, or health service use outcomes. Results Fifty‐four articles were included for data synthesis, representing studies from all continents. In 11 studies in which there was an appropriate urban population comparator, rural and remote populations were not at increased risk for RA; 1 study reported increased prevalence, and 5 studies reported decreased prevalence in rural and remote populations. Clinical characteristics of rural and remote populations in studies with an appropriate urban comparator showed no significant differences in disease activity measures or disability, but 1 study reported worse physical function and health‐related quality of life in rural and remote populations. Studies reporting on health service use provided evidence that rural and remote residence adversely impacts diagnostic time, ongoing follow‐up, access to RA‐care–related practitioners and services, and variation in medication access and use, with prominent heterogeneity noted between countries. Conclusion RA epidemiology and clinical outcomes are not necessarily different between rural/remote and urban populations within countries. Rural and remote patients face greater barriers to care, which increases the risk for inequities in outcomes.
Collapse
Affiliation(s)
| | - Kelsey Chomistek
- Medical Sciences Faculty of Graduate Studies University of Calgary Calgary AB Canada
| | - Ralph Hsiao
- Medical Education Faculty of Medicine & Dentistry University of Alberta Edmonton AB Canada
| | - Salman Anwar
- Medical Education University of Saskatchewan Saskatoon SK Canada
| | | | - Glen Hazlewood
- Departments of Medicine and Community Health Sciences Cumming School of Medicine University of Calgary Calgary AB Canada
| | - Cheryl Barnabe
- Departments of Medicine and Community Health Sciences Cumming School of Medicine University of Calgary 3330 Hospital Dr NW Calgary AB T2N 4N1 Canada
| |
Collapse
|
14
|
Barnabe C. Disparities in Rheumatoid Arthritis Care and Health Service Solutions to Equity. Rheum Dis Clin North Am 2020; 46:685-692. [DOI: 10.1016/j.rdc.2020.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
|
15
|
Barber CEH, Lacaille D, Faris P, Mosher D, Katz S, Patel JN, Zhang S, Yee K, Barnabe C, Hazlewood GS, Bykerk V, Shiff NJ, Twilt M, Burt J, Benseler SM, Homik J, Marshall DA. Evaluating Quality of Care for Rheumatoid Arthritis for the Population of Alberta Using System-level Performance Measures. J Rheumatol 2020; 48:482-485. [PMID: 32934120 DOI: 10.3899/jrheum.200420] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2020] [Indexed: 12/28/2022]
Abstract
OBJECTIVE We evaluated 4 national rheumatoid arthritis (RA) system-level performance measures (PM) in Alberta, Canada. METHODS Incident and prevalent RA cases ≥ 16 years of age since 2002 were identified using a validated case definition applied in provincial administrative data. Performance was ascertained through analysis of health data between fiscal years 2012/13-2015/16. Measures evaluated were as follows: proportion of incident RA cases with a rheumatologist visit within 1 year of first RA diagnosis code (PM1); proportion of prevalent RA patients who were dispensed a disease-modifying antirheumatic drug (DMARD) annually (PM2); time from first visit with an RA code to DMARD dispensation and proportion of incident cases where the 14-day benchmark for dispensation was met (PM3); and proportion of patients seen in annual follow-up (PM4). RESULTS There were 31,566 prevalent and 2730 incident RA cases (2012/13). Over the analysis period, the proportion of patients seen by a rheumatologist within 1 year of onset (PM1) increased from 55% to 63%; however, the proportion of RA patients dispensed DMARD annually (PM2) remained low at 43%. While the median time to DMARD from first visit date in people who received DMARD improved over time from 39 days to 28 days, only 38-41% of patients received treatment within the 14-day benchmark (PM3). The percentage of patients seen in yearly follow-up (PM4) varied between 73-80%. CONCLUSION The existing Alberta healthcare system for RA is suboptimal, indicating barriers to accessing specialty care and treatment. Our results inform quality improvement initiatives required within the province to meet national standards of care.
Collapse
Affiliation(s)
- Claire E H Barber
- C.E. Barber, MD, FRCPC, PhD, Assistant Professor, C. Barnabe, MD, FRCPC, MSc, Associate Professor, G.S. Hazlewood, MD, FRCPC, PhD, Associate Professor, D.A. Marshall, PhD, Professor, Department of Medicine, Cumming School of Medicine, University of Calgary, and Department of Community Health Sciences, University of Calgary, and Arthritis Research Canada, and McCaig Bone and Joint Health Institute, Calgary, Alberta, Canada;
| | - Diane Lacaille
- D. Lacaille, MD, FRCPC, MHSc, Professor, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada, and Scientific Director, Arthritis Research Canada
| | - Peter Faris
- P. Faris, PhD, Director, Health Services Statistical and Analytic Methods Analytics (DIMER), S. Zhang, MSc, Senior Data Analyst, K. Yee, MSc, MPH, Senior Data Analyst, Alberta Health Services, Calgary, Alberta, Canada
| | - Dianne Mosher
- D. Mosher, MD, FRCPC, Professor, Department of Medicine, Cumming School of Medicine, University of Calgary, and McCaig Bone and Joint Health Institute, Calgary, Alberta, Canada
| | - Steven Katz
- S. Katz, MD, FRCPC, J. Homik, MD, FRCPC, MSc, Professor, Department of Medicine, University of Alberta, Calgary, Alberta, Canada
| | - Jatin N Patel
- J.N. Patel, MBT, Project Manager, Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Sharon Zhang
- P. Faris, PhD, Director, Health Services Statistical and Analytic Methods Analytics (DIMER), S. Zhang, MSc, Senior Data Analyst, K. Yee, MSc, MPH, Senior Data Analyst, Alberta Health Services, Calgary, Alberta, Canada
| | - Karen Yee
- P. Faris, PhD, Director, Health Services Statistical and Analytic Methods Analytics (DIMER), S. Zhang, MSc, Senior Data Analyst, K. Yee, MSc, MPH, Senior Data Analyst, Alberta Health Services, Calgary, Alberta, Canada
| | - Cheryl Barnabe
- C.E. Barber, MD, FRCPC, PhD, Assistant Professor, C. Barnabe, MD, FRCPC, MSc, Associate Professor, G.S. Hazlewood, MD, FRCPC, PhD, Associate Professor, D.A. Marshall, PhD, Professor, Department of Medicine, Cumming School of Medicine, University of Calgary, and Department of Community Health Sciences, University of Calgary, and Arthritis Research Canada, and McCaig Bone and Joint Health Institute, Calgary, Alberta, Canada
| | - Glen S Hazlewood
- C.E. Barber, MD, FRCPC, PhD, Assistant Professor, C. Barnabe, MD, FRCPC, MSc, Associate Professor, G.S. Hazlewood, MD, FRCPC, PhD, Associate Professor, D.A. Marshall, PhD, Professor, Department of Medicine, Cumming School of Medicine, University of Calgary, and Department of Community Health Sciences, University of Calgary, and Arthritis Research Canada, and McCaig Bone and Joint Health Institute, Calgary, Alberta, Canada
| | - Vivian Bykerk
- V. Bykerk, MD, FRCPC, Associate Professor, Hospital for Special Services, New York, New York, USA
| | - Natalie J Shiff
- N. J. Shiff, MD, MHSc, Adjunct Professor, Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Marinka Twilt
- M. Twilt, MD, MSCE, PhD, Assistant Professor, S.M. Benseler, MD, PhD, Professor, Department of Pediatrics, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jennifer Burt
- J. Burt, PT, ACPAC-trained ERP, St Clare's Mercy Hospital, St. John's, Newfoundland, Canada
| | - Susanne M Benseler
- M. Twilt, MD, MSCE, PhD, Assistant Professor, S.M. Benseler, MD, PhD, Professor, Department of Pediatrics, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Joanne Homik
- S. Katz, MD, FRCPC, J. Homik, MD, FRCPC, MSc, Professor, Department of Medicine, University of Alberta, Calgary, Alberta, Canada
| | - Deborah A Marshall
- C.E. Barber, MD, FRCPC, PhD, Assistant Professor, C. Barnabe, MD, FRCPC, MSc, Associate Professor, G.S. Hazlewood, MD, FRCPC, PhD, Associate Professor, D.A. Marshall, PhD, Professor, Department of Medicine, Cumming School of Medicine, University of Calgary, and Department of Community Health Sciences, University of Calgary, and Arthritis Research Canada, and McCaig Bone and Joint Health Institute, Calgary, Alberta, Canada
| |
Collapse
|
16
|
Hollick RJ, Stelfox K, Dean LE, Shim J, Walker-Bone K, Macfarlane GJ. Outcomes and treatment responses, including work productivity, among people with axial spondyloarthritis living in urban and rural areas: a mixed-methods study within a national register. Ann Rheum Dis 2020; 79:1055-1062. [PMID: 32522742 PMCID: PMC7392479 DOI: 10.1136/annrheumdis-2020-216988] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 05/08/2020] [Accepted: 05/12/2020] [Indexed: 11/26/2022]
Abstract
Objective To examine differences in clinical and patient-reported outcomes, including work, in individuals with axial spondyloarthritis (axSpA) living in rural and urban settings. Methods Using a sequential, explanatory mixed-method design, data from the British Society for Rheumatology Biologics Register for Ankylosing Spondylitis were used to (1) characterise participants with axSpA living in rural and urban areas and (b) assess any differences in outcome after commencement of biologic therapy (phase 1). Semistructured interviews (phase 2) further explored the results from phase 1. Results Patients with axSpA living in rural areas were older and more likely to work in a physical job. Among patients prescribed biologics, there were no differences in response to biologics, but after adjustment for age, sex and local area deprivation rural dwellers reported more presenteeism and overall work impairment. Work effects could be explained by accounting for individual differences in disease activity, fatigue, physical function and job type. Interviews highlighted the complex relationship between clinical factors, contextual factors (work environment, job demands) and work disability. The ability to work and flexibility in terms of what, when and how tasks are undertaken were important. Support from employers was variable and healthcare professionals were often perceived as unsupportive. Conclusions Patients with axSpA living in rural areas report a greater impact of their disease on work productivity. New measures are needed to capture important contextual factors and comprehensively determine the impact of long-term conditions on work. Future European League Against Rheumatism axSpA recommendations should include support to work as a target to optimise quality of life in patients with axSpA.
Collapse
Affiliation(s)
- Rosemary J Hollick
- Aberdeen Centre for Arthritis and Musculoskeletal Health, Epidemiology Group, University of Aberdeen, Aberdeen, UK
- MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Aberdeen, Aberdeen, UK
- Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Kevin Stelfox
- Aberdeen Centre for Arthritis and Musculoskeletal Health, Epidemiology Group, University of Aberdeen, Aberdeen, UK
- MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Aberdeen, Aberdeen, UK
- Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Linda E Dean
- Aberdeen Centre for Arthritis and Musculoskeletal Health, Epidemiology Group, University of Aberdeen, Aberdeen, UK
- MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Aberdeen, Aberdeen, UK
- Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Joanna Shim
- Aberdeen Centre for Arthritis and Musculoskeletal Health, Epidemiology Group, University of Aberdeen, Aberdeen, UK
- MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Aberdeen, Aberdeen, UK
- Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Karen Walker-Bone
- MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Southampton, Southampton, UK
| | - Gary J Macfarlane
- Aberdeen Centre for Arthritis and Musculoskeletal Health, Epidemiology Group, University of Aberdeen, Aberdeen, UK
- MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Aberdeen, Aberdeen, UK
- Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| |
Collapse
|
17
|
Hollick RJ, Macfarlane GJ. Association of Rural Setting With Poorer Disease Outcomes for Patients With Rheumatic Diseases: Results From a Systematic Review of the Literature. Arthritis Care Res (Hoboken) 2020; 73:666-670. [PMID: 32170834 DOI: 10.1002/acr.24185] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 03/03/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To assess whether clinical and patient-reported outcomes are poorer for individuals with inflammatory and noninflammatory rheumatic diseases living in rural locations. METHODS We searched 6 databases for articles that reported on primary peer-reviewed research, published in English between 1990 and 2019, that focused on selected rheumatic diseases (rheumatoid arthritis [RA], psoriatic arthritis, axial spondyloarthritis, or osteoarthritis [OA]) and quantified either patient-reported or clinically measured outcomes by a measure of rurality or remoteness. Selected articles were synthesized narratively. RESULTS Eight eligible publications, including 753 rural and 929 urban patients, evaluated outcomes in RA (5 studies) and OA (3 studies). Studies were small, single center, and rarely provided a definition of rurality. Aspects relating to rurality, such as access to services, were not measured. In RA, some studies suggested greater functional disability and disease activity in rural dwellers. In OA, there was some evidence to suggest that rural dwellers presented with more advanced degenerative hip changes, and that illness perceptions and coping differed between rural and urban dwellers. No studies examined work outcomes. Potentially important confounding factors such as socioeconomic status were rarely considered. CONCLUSION There remains considerable uncertainty whether outcomes differ for patients with rheumatic disease in rural settings. There is a need for larger scale studies characterizing participants in relation to place of residence in order to determine whether rurality is an independent predictor of outcome or a surrogate marker for socioeconomic factors.
Collapse
|
18
|
Ehrmann Feldman D, Bernatsky S, Orozco T, El-Khoury J, Desmeules F, Laliberté M, Perreault K, Grad R, Zummer M, Woodhouse L. Physical Therapists' Ability to Distinguish Between Inflammatory and Noninflammatory Arthritis and to Appropriately Refer Patients to a Rheumatologist. Arthritis Care Res (Hoboken) 2019; 72:1747-1754. [PMID: 31560453 DOI: 10.1002/acr.24081] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 09/24/2019] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To investigate whether physical therapists (PTs) can correctly identify new-onset inflammatory arthritis; to assess whether PTs are aware that cases of new-onset inflammatory arthritis should be referred to a rheumatologist; to explore the comfort level of PTs to refer to medical specialists; and to determine factors associated with correctly identifying inflammatory arthritis and referring to a rheumatologist. METHODS We sent a questionnaire to PTs in 2 Canadian provinces describing 4 case scenarios (new-onset rheumatoid arthritis [RA], knee osteoarthritis [OA], new-onset ankylosing spondylitis [AS], and low back pain [LBP]). Participants were asked to identify probable medical diagnoses and indicate their plan of action. We described the frequencies of our outcomes and used logistic regression to explore associated factors. RESULTS A total of 352 PTs responded. The proportions who correctly identified each of the 4 cases were 90%, 83%, 77%, and 100%, respectively, for RA, OA, AS, and LBP. Among those, 77%, 30%, 73%, and 3%, respectively, indicated that it was "very important" or "extremely important" to refer to a rheumatologist. Approximately two-thirds felt "extremely comfortable" or "quite comfortable" to refer to a specialist. PTs working in rural areas were less likely to refer. CONCLUSION Most PTs correctly identified the clinical cases and were aware of the importance of prompt referral to a rheumatologist for inflammatory disease. Most indicated that it was not very important to refer those with OA and LBP. This implies that many PTs can distinguish between inflammatory and noninflammatory conditions and appropriately refer patients with suspected inflammatory arthritis to a rheumatologist.
Collapse
Affiliation(s)
| | - Sasha Bernatsky
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | | | | | | | | | - Kadija Perreault
- Center for Interdisciplinary Research in Rehabilitation and Social Integration and Université Laval, Quebec, Quebec, Canada
| | - Roland Grad
- Jewish General Hospital, Montreal, Quebec, Canada
| | | | | |
Collapse
|
19
|
Hall J, Julia Kaal K, Lee J, Duncan R, Tsao N, Harrison M. Patient Satisfaction and Costs of Multidisciplinary Models of Care in Rheumatology: a Review of the Recent Literature. Curr Rheumatol Rep 2018; 20:19. [DOI: 10.1007/s11926-018-0727-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
|
20
|
Rostom K, Smith CD, Liddy C, Afkham A, Keely E. Improving Access to Rheumatologists: Use and Benefits of an Electronic Consultation Service. J Rheumatol 2017; 45:137-140. [DOI: 10.3899/jrheum.161529] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2017] [Indexed: 11/22/2022]
Abstract
Objective.To describe the use and benefits of an innovative eConsult service to improve access to rheumatologists.Methods.There were 225 eConsults directed to rheumatology that were categorized by type of question and effect on face-to-face referral rates.Results.The median response time by the rheumatologists was 1.9 days. Clinical questions included drug treatment (34%), diagnosis (26%), or management (14%). Osteoporosis was the most common diagnosis (22%), followed by pain in multiple joints (11%), and polyarthritis (10%). A face-to-face referral was avoided in 38% of cases.Conclusion.There are clinical questions that can be answered quickly by an eConsult, improving access to rheumatologists.
Collapse
|
21
|
Hall JJ, Katz SJ, Cor MK. Patient Satisfaction with Pharmacist-Led Collaborative Follow-Up Care in an Ambulatory Rheumatology Clinic. Musculoskeletal Care 2017; 15:186-195. [PMID: 27686752 DOI: 10.1002/msc.1160] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVES Patient satisfaction is known to increase with pharmacist intervention in general outpatient clinics and with nurse-led care in rheumatology clinics. The aim of the present study was to describe and compare patient satisfaction with two different types of care: a pharmacist physician collaborative model and a traditional physician model in a rheumatology clinic setting. METHODS A cross-sectional survey of inflammatory arthritis patients seen during a follow-up visit in Edmonton, Alberta, Canada, was conducted over a ten-week period. Patient satisfaction was measured using a modified version of the validated Leeds Satisfaction Questionnaire, which uses a five-point Likert scale to measure six dimensions of satisfaction, and compared between the collaborative care and traditional physician models. RESULTS A total of 62 patients completed the questionnaire (21 collaborative care and 41 traditional physician model). The average age of respondents was 52 years and the majority were female. The mean score for satisfaction across the six dimensions was 4.56 in the collaborative care group and 4.30 in the traditional physician group (p = 0.02). Patient satisfaction in the collaborative care group was consistently higher across all dimensions. No difference was noted between participants seen for the first time compared with those seen two or more times by the pharmacist. CONCLUSIONS A collaborative care model can exceed the already high expectations for care of patients with inflammatory arthritis. Our findings support the role of pharmacists using a collaborative care approach to care for patients in rheumatology clinics.
Collapse
Affiliation(s)
- Jill J Hall
- Faculty of Pharmacy & Pharmaceutical Sciences, University of Alberta, Edmonton, AB, Canada
| | - Steven J Katz
- Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - M Ken Cor
- Faculty of Pharmacy & Pharmaceutical Sciences, University of Alberta, Edmonton, AB, Canada
| |
Collapse
|
22
|
Brophy J, Marshall DA, Badley EM, Hanly JG, Averns H, Ellsworth J, Pope JE, Barber CEH. Measuring the Rheumatology Workforce in Canada: A Literature Review. J Rheumatol 2016; 43:1121-9. [PMID: 27036382 DOI: 10.3899/jrheum.151174] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The number of rheumatologists per capita has been proposed as a performance measure for arthritis care. This study reviews what is known about the rheumatologist workforce in Canada. METHODS A systematic search was conducted in EMBASE and MEDLINE using the search themes "rheumatology" AND "workforce" AND "Canada" from 2000 until December 2014. Additionally, workforce databases and rheumatology websites were searched. Data were abstracted on the numbers of rheumatologists, demographics, retirement projections, and barriers to healthcare. RESULTS Twenty-five sources for rheumatology workforce information were found: 6 surveys, 14 databases, 2 patient/provider resources, and 3 epidemiologic studies. Recent estimates say there are 398 to 428 rheumatologists in Canada, but there were limited data on allocation of time to clinical practice. Although the net number of rheumatologists has increased, the mean age was ≥ 47.7 years, and up to one-third are planning to retire in the next decade. There is a clustering of rheumatologists around academic centers, while some provinces/territories have suboptimal ratios of rheumatologists per capita (range 0-1.1). Limited information was found on whether rural areas are receiving adequate services. The most consistent barrier reported by rheumatologists was lack of allied health professionals. CONCLUSION In Canada there are regional disparities in access to rheumatologist care and an aging rheumatologist workforce. To address these workforce capacity issues, better data are needed including information on clinical full-time equivalents, delivery of care to remote communities, and use of alternative models of care to increase clinical capacity.
Collapse
Affiliation(s)
- Julie Brophy
- From the Department of Community Health Sciences, Cumming School of Medicine, and the Division of Rheumatology, Department of Medicine, and McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta; Toronto Western Research Institute, University of Toronto, Toronto, Ontario; Dalhousie University, Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia; Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton; Division of Rheumatology, University of Western Ontario, London, Ontario, Canada.J. Brophy, MD, FRCPC, rheumatologist in private practice, Guelph, Ontario, Canada; D.A. Marshall, PhD, Professor, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, McCaig Institute for Bone and Joint Health; E.M. Badley, PhD, Toronto Western Research Institute, University of Toronto; J.G. Hanly, MD, Professor of Medicine (Rheumatology) and Pathology, Dalhousie University, attending staff rheumatologist, Queen Elizabeth II Health Sciences Center; H. Averns, MB, ChB, FRCP ( UK), FRCPC, rheumatologist in private practice, Kingston, Ontario, Canada; J. Ellsworth, MD, FRCPC, Professor and Head, Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; J.E. Pope, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, University of Western Ontario; C.E. Barber, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health
| | - Deborah A Marshall
- From the Department of Community Health Sciences, Cumming School of Medicine, and the Division of Rheumatology, Department of Medicine, and McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta; Toronto Western Research Institute, University of Toronto, Toronto, Ontario; Dalhousie University, Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia; Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton; Division of Rheumatology, University of Western Ontario, London, Ontario, Canada.J. Brophy, MD, FRCPC, rheumatologist in private practice, Guelph, Ontario, Canada; D.A. Marshall, PhD, Professor, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, McCaig Institute for Bone and Joint Health; E.M. Badley, PhD, Toronto Western Research Institute, University of Toronto; J.G. Hanly, MD, Professor of Medicine (Rheumatology) and Pathology, Dalhousie University, attending staff rheumatologist, Queen Elizabeth II Health Sciences Center; H. Averns, MB, ChB, FRCP ( UK), FRCPC, rheumatologist in private practice, Kingston, Ontario, Canada; J. Ellsworth, MD, FRCPC, Professor and Head, Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; J.E. Pope, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, University of Western Ontario; C.E. Barber, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health
| | - Elizabeth M Badley
- From the Department of Community Health Sciences, Cumming School of Medicine, and the Division of Rheumatology, Department of Medicine, and McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta; Toronto Western Research Institute, University of Toronto, Toronto, Ontario; Dalhousie University, Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia; Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton; Division of Rheumatology, University of Western Ontario, London, Ontario, Canada.J. Brophy, MD, FRCPC, rheumatologist in private practice, Guelph, Ontario, Canada; D.A. Marshall, PhD, Professor, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, McCaig Institute for Bone and Joint Health; E.M. Badley, PhD, Toronto Western Research Institute, University of Toronto; J.G. Hanly, MD, Professor of Medicine (Rheumatology) and Pathology, Dalhousie University, attending staff rheumatologist, Queen Elizabeth II Health Sciences Center; H. Averns, MB, ChB, FRCP ( UK), FRCPC, rheumatologist in private practice, Kingston, Ontario, Canada; J. Ellsworth, MD, FRCPC, Professor and Head, Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; J.E. Pope, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, University of Western Ontario; C.E. Barber, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health
| | - John G Hanly
- From the Department of Community Health Sciences, Cumming School of Medicine, and the Division of Rheumatology, Department of Medicine, and McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta; Toronto Western Research Institute, University of Toronto, Toronto, Ontario; Dalhousie University, Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia; Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton; Division of Rheumatology, University of Western Ontario, London, Ontario, Canada.J. Brophy, MD, FRCPC, rheumatologist in private practice, Guelph, Ontario, Canada; D.A. Marshall, PhD, Professor, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, McCaig Institute for Bone and Joint Health; E.M. Badley, PhD, Toronto Western Research Institute, University of Toronto; J.G. Hanly, MD, Professor of Medicine (Rheumatology) and Pathology, Dalhousie University, attending staff rheumatologist, Queen Elizabeth II Health Sciences Center; H. Averns, MB, ChB, FRCP ( UK), FRCPC, rheumatologist in private practice, Kingston, Ontario, Canada; J. Ellsworth, MD, FRCPC, Professor and Head, Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; J.E. Pope, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, University of Western Ontario; C.E. Barber, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health
| | - Henry Averns
- From the Department of Community Health Sciences, Cumming School of Medicine, and the Division of Rheumatology, Department of Medicine, and McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta; Toronto Western Research Institute, University of Toronto, Toronto, Ontario; Dalhousie University, Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia; Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton; Division of Rheumatology, University of Western Ontario, London, Ontario, Canada.J. Brophy, MD, FRCPC, rheumatologist in private practice, Guelph, Ontario, Canada; D.A. Marshall, PhD, Professor, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, McCaig Institute for Bone and Joint Health; E.M. Badley, PhD, Toronto Western Research Institute, University of Toronto; J.G. Hanly, MD, Professor of Medicine (Rheumatology) and Pathology, Dalhousie University, attending staff rheumatologist, Queen Elizabeth II Health Sciences Center; H. Averns, MB, ChB, FRCP ( UK), FRCPC, rheumatologist in private practice, Kingston, Ontario, Canada; J. Ellsworth, MD, FRCPC, Professor and Head, Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; J.E. Pope, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, University of Western Ontario; C.E. Barber, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health
| | - Janet Ellsworth
- From the Department of Community Health Sciences, Cumming School of Medicine, and the Division of Rheumatology, Department of Medicine, and McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta; Toronto Western Research Institute, University of Toronto, Toronto, Ontario; Dalhousie University, Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia; Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton; Division of Rheumatology, University of Western Ontario, London, Ontario, Canada.J. Brophy, MD, FRCPC, rheumatologist in private practice, Guelph, Ontario, Canada; D.A. Marshall, PhD, Professor, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, McCaig Institute for Bone and Joint Health; E.M. Badley, PhD, Toronto Western Research Institute, University of Toronto; J.G. Hanly, MD, Professor of Medicine (Rheumatology) and Pathology, Dalhousie University, attending staff rheumatologist, Queen Elizabeth II Health Sciences Center; H. Averns, MB, ChB, FRCP ( UK), FRCPC, rheumatologist in private practice, Kingston, Ontario, Canada; J. Ellsworth, MD, FRCPC, Professor and Head, Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; J.E. Pope, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, University of Western Ontario; C.E. Barber, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health
| | - Janet E Pope
- From the Department of Community Health Sciences, Cumming School of Medicine, and the Division of Rheumatology, Department of Medicine, and McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta; Toronto Western Research Institute, University of Toronto, Toronto, Ontario; Dalhousie University, Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia; Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton; Division of Rheumatology, University of Western Ontario, London, Ontario, Canada.J. Brophy, MD, FRCPC, rheumatologist in private practice, Guelph, Ontario, Canada; D.A. Marshall, PhD, Professor, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, McCaig Institute for Bone and Joint Health; E.M. Badley, PhD, Toronto Western Research Institute, University of Toronto; J.G. Hanly, MD, Professor of Medicine (Rheumatology) and Pathology, Dalhousie University, attending staff rheumatologist, Queen Elizabeth II Health Sciences Center; H. Averns, MB, ChB, FRCP ( UK), FRCPC, rheumatologist in private practice, Kingston, Ontario, Canada; J. Ellsworth, MD, FRCPC, Professor and Head, Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; J.E. Pope, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, University of Western Ontario; C.E. Barber, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health
| | - Claire E H Barber
- From the Department of Community Health Sciences, Cumming School of Medicine, and the Division of Rheumatology, Department of Medicine, and McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta; Toronto Western Research Institute, University of Toronto, Toronto, Ontario; Dalhousie University, Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia; Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton; Division of Rheumatology, University of Western Ontario, London, Ontario, Canada.J. Brophy, MD, FRCPC, rheumatologist in private practice, Guelph, Ontario, Canada; D.A. Marshall, PhD, Professor, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, McCaig Institute for Bone and Joint Health; E.M. Badley, PhD, Toronto Western Research Institute, University of Toronto; J.G. Hanly, MD, Professor of Medicine (Rheumatology) and Pathology, Dalhousie University, attending staff rheumatologist, Queen Elizabeth II Health Sciences Center; H. Averns, MB, ChB, FRCP ( UK), FRCPC, rheumatologist in private practice, Kingston, Ontario, Canada; J. Ellsworth, MD, FRCPC, Professor and Head, Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; J.E. Pope, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, University of Western Ontario; C.E. Barber, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health.
| |
Collapse
|
23
|
Ankylosing spondylitis diagnosis in US patients with back pain: identifying providers involved and factors associated with rheumatology referral delay. Clin Rheumatol 2016; 35:1769-76. [PMID: 26987341 PMCID: PMC4914524 DOI: 10.1007/s10067-016-3231-z] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 02/22/2016] [Accepted: 03/05/2016] [Indexed: 11/30/2022]
Abstract
This study aimed to identify providers involved in diagnosing ankylosing spondylitis (AS) following back pain diagnosis in the USA and to identify factors leading to the delay in rheumatology referrals. The Truven Health MarketScan® US Commercial Database was searched for patients aged 18–64 years with back pain diagnosis in a non-rheumatology setting followed by AS diagnosis in any setting during January 2000–December 2012. Patients with a rheumatologist visit on or before AS diagnosis were considered referred. Cox regression was used to determine factors associated with referral time after adjusting for age, sex, comorbidities, physician specialty, drug therapy, and imaging procedures. Of 3336 patients included, 1244 (37 %) were referred to and diagnosed by rheumatologists; the others were diagnosed in primary care (25.7 %), chiropractic/physical therapy (7 %), orthopedic surgery (3.8 %), pain clinic (3.6 %), acute care (3.4 %), and other (19.2 %) settings. Median time from back pain diagnosis to rheumatology referral was 307 days and from first rheumatologist visit to AS diagnosis was 28 days. Referred patients were more likely to be younger (hazard ratio [HR] = 0.986; p < 0.0001), male (HR = 1.15; p = 0.0163), diagnosed with uveitis (HR = 1.49; p = 0.0050), referred by primary care physicians (HR = 1.96; p < 0.0001), prescribed non-steroidal anti-inflammatory drugs (HR = 1.55; p < 0.0001), disease-modifying antirheumatic drugs (HR = 1.33; p < 0.0001), and tumor necrosis factor inhibitors (HR = 1.40; p = 0.0036), and to have had spinal/pelvic X-ray prior to referral (HR = 1.28; p = 0.0003). During 2000–2012, most patients with AS were diagnosed outside of rheumatology practices. The delay before referral to rheumatology was 10 months; AS diagnosis generally followed within a month. Earlier referral of patients with AS signs and symptoms may lead to more timely diagnosis and appropriate treatment.
Collapse
|
24
|
Widdifield J, Moura CS, Wang Y, Abrahamowicz M, Paterson JM, Huang A, Beauchamp ME, Boire G, Fortin PR, Bessette L, Bombardier C, Hanly JG, Feldman D, Bernatsky S. The Longterm Effect of Early Intensive Treatment of Seniors with Rheumatoid Arthritis: A Comparison of 2 Population-based Cohort Studies on Time to Joint Replacement Surgery. J Rheumatol 2016; 43:861-8. [PMID: 26879353 DOI: 10.3899/jrheum.151156] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2016] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Disease-modifying antirheumatic drugs (DMARD) have the greatest effect when initiated early. We evaluated the influence of early exposure to DMARD on time to joint replacement surgery among patients with incident rheumatoid arthritis (RA). METHOD Using a common protocol, we undertook 2 independent population-based cohort studies of patients with incident RA aged 66 years or older in Ontario (ON) and Quebec (QC) covering the period 2000-2013. We used Cox proportional hazards regression with time-dependent variables measuring duration of drug use in the first year, separately for methotrexate (MTX) and other DMARD, adjusting for baseline demographics, clinical factors, and other potentially confounding drug exposures. Our outcome measure was any joint replacement derived from standardized procedure codes. Adjusted HR and 95% CI were estimated. RESULTS Among 20,918 ON and 6754 QC patients with RA followed for a median of 4.5 years, 2201 and 494 patients underwent joint replacement surgery for crude event rates of 2.0 and 1.4 per 100 person-years, respectively. Greater cumulative exposure to MTX (HR 0.97, 95% CI 0.95-0.98) and other DMARD (HR 0.98, 95% CI 0.97-0.99) in the first year after diagnosis was associated with longer times to joint replacement in ON, corresponding to a 2-3% decrease in the hazard of surgery with each additional month of early use. Similar results were observed in QC. CONCLUSION Greater duration of exposure to DMARD soon after RA diagnosis was associated with delays to joint replacement surgery in both provinces. Early intensive treatment of RA may ultimately reduce demand for joint replacement surgery.
Collapse
Affiliation(s)
- Jessica Widdifield
- From the Department of Epidemiology, Biostatistics and Occupational Health, McGill University; Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre; École de Réadaptation, Université de Montréal, Montreal; Department of Medicine, Université de Sherbrooke, Sherbrooke; Division of Rheumatology, Department of Medicine, Centre de recherche du CHU de Québec, Université Laval, Quebec City, Quebec; Institute for Clinical Evaluative Sciences, University of Toronto; Institute of Health Policy, Management and Evaluation; Division of Rheumatology, University of Toronto, Toronto; Department of Family Medicine, McMaster University, Hamilton, Ontario; Division of Rheumatology, Departments of Medicine and Pathology, Dalhousie University, Halifax, Nova Scotia, Canada.J. Widdifield, PhD, Department of Epidemiology, Biostatistics and Occupational Health, McGill University, and Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, and Institute for Clinical Evaluative Sciences; C.S. Moura, PhD, Department of Epidemiology, Biostatistics and Occupational Health, McGill University, and Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre; Y. Wang, PhD(c), Department of Epidemiology, Biostatistics and Occupational Health, McGill University; M. Abrahamowicz, PhD, Department of Epidemiology, Biostatistics and Occupational Health, McGill University; J.M. Paterson, MSc, Institute for Clinical Evaluative Sciences, and University of Toronto, Institute of Health Policy, Management and Evaluation, and Department of Family Medicine, McMaster University; A. Huang, MSc, Institute for Clinical Evaluative Sciences; M.E. Beauchamp, PhD, Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre; G. Boire, MD, FRCPC, MSc, Department of Medicine, Université de Sherbrooke; P.R. Fortin, MD, FRCPC, MPH, Division of Rheumatology, Department of Medic
| | - Cristiano S Moura
- From the Department of Epidemiology, Biostatistics and Occupational Health, McGill University; Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre; École de Réadaptation, Université de Montréal, Montreal; Department of Medicine, Université de Sherbrooke, Sherbrooke; Division of Rheumatology, Department of Medicine, Centre de recherche du CHU de Québec, Université Laval, Quebec City, Quebec; Institute for Clinical Evaluative Sciences, University of Toronto; Institute of Health Policy, Management and Evaluation; Division of Rheumatology, University of Toronto, Toronto; Department of Family Medicine, McMaster University, Hamilton, Ontario; Division of Rheumatology, Departments of Medicine and Pathology, Dalhousie University, Halifax, Nova Scotia, Canada.J. Widdifield, PhD, Department of Epidemiology, Biostatistics and Occupational Health, McGill University, and Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, and Institute for Clinical Evaluative Sciences; C.S. Moura, PhD, Department of Epidemiology, Biostatistics and Occupational Health, McGill University, and Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre; Y. Wang, PhD(c), Department of Epidemiology, Biostatistics and Occupational Health, McGill University; M. Abrahamowicz, PhD, Department of Epidemiology, Biostatistics and Occupational Health, McGill University; J.M. Paterson, MSc, Institute for Clinical Evaluative Sciences, and University of Toronto, Institute of Health Policy, Management and Evaluation, and Department of Family Medicine, McMaster University; A. Huang, MSc, Institute for Clinical Evaluative Sciences; M.E. Beauchamp, PhD, Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre; G. Boire, MD, FRCPC, MSc, Department of Medicine, Université de Sherbrooke; P.R. Fortin, MD, FRCPC, MPH, Division of Rheumatology, Department of Medic
| | - Yishu Wang
- From the Department of Epidemiology, Biostatistics and Occupational Health, McGill University; Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre; École de Réadaptation, Université de Montréal, Montreal; Department of Medicine, Université de Sherbrooke, Sherbrooke; Division of Rheumatology, Department of Medicine, Centre de recherche du CHU de Québec, Université Laval, Quebec City, Quebec; Institute for Clinical Evaluative Sciences, University of Toronto; Institute of Health Policy, Management and Evaluation; Division of Rheumatology, University of Toronto, Toronto; Department of Family Medicine, McMaster University, Hamilton, Ontario; Division of Rheumatology, Departments of Medicine and Pathology, Dalhousie University, Halifax, Nova Scotia, Canada.J. Widdifield, PhD, Department of Epidemiology, Biostatistics and Occupational Health, McGill University, and Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, and Institute for Clinical Evaluative Sciences; C.S. Moura, PhD, Department of Epidemiology, Biostatistics and Occupational Health, McGill University, and Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre; Y. Wang, PhD(c), Department of Epidemiology, Biostatistics and Occupational Health, McGill University; M. Abrahamowicz, PhD, Department of Epidemiology, Biostatistics and Occupational Health, McGill University; J.M. Paterson, MSc, Institute for Clinical Evaluative Sciences, and University of Toronto, Institute of Health Policy, Management and Evaluation, and Department of Family Medicine, McMaster University; A. Huang, MSc, Institute for Clinical Evaluative Sciences; M.E. Beauchamp, PhD, Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre; G. Boire, MD, FRCPC, MSc, Department of Medicine, Université de Sherbrooke; P.R. Fortin, MD, FRCPC, MPH, Division of Rheumatology, Department of Medic
| | - Michal Abrahamowicz
- From the Department of Epidemiology, Biostatistics and Occupational Health, McGill University; Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre; École de Réadaptation, Université de Montréal, Montreal; Department of Medicine, Université de Sherbrooke, Sherbrooke; Division of Rheumatology, Department of Medicine, Centre de recherche du CHU de Québec, Université Laval, Quebec City, Quebec; Institute for Clinical Evaluative Sciences, University of Toronto; Institute of Health Policy, Management and Evaluation; Division of Rheumatology, University of Toronto, Toronto; Department of Family Medicine, McMaster University, Hamilton, Ontario; Division of Rheumatology, Departments of Medicine and Pathology, Dalhousie University, Halifax, Nova Scotia, Canada.J. Widdifield, PhD, Department of Epidemiology, Biostatistics and Occupational Health, McGill University, and Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, and Institute for Clinical Evaluative Sciences; C.S. Moura, PhD, Department of Epidemiology, Biostatistics and Occupational Health, McGill University, and Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre; Y. Wang, PhD(c), Department of Epidemiology, Biostatistics and Occupational Health, McGill University; M. Abrahamowicz, PhD, Department of Epidemiology, Biostatistics and Occupational Health, McGill University; J.M. Paterson, MSc, Institute for Clinical Evaluative Sciences, and University of Toronto, Institute of Health Policy, Management and Evaluation, and Department of Family Medicine, McMaster University; A. Huang, MSc, Institute for Clinical Evaluative Sciences; M.E. Beauchamp, PhD, Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre; G. Boire, MD, FRCPC, MSc, Department of Medicine, Université de Sherbrooke; P.R. Fortin, MD, FRCPC, MPH, Division of Rheumatology, Department of Medic
| | - J Michael Paterson
- From the Department of Epidemiology, Biostatistics and Occupational Health, McGill University; Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre; École de Réadaptation, Université de Montréal, Montreal; Department of Medicine, Université de Sherbrooke, Sherbrooke; Division of Rheumatology, Department of Medicine, Centre de recherche du CHU de Québec, Université Laval, Quebec City, Quebec; Institute for Clinical Evaluative Sciences, University of Toronto; Institute of Health Policy, Management and Evaluation; Division of Rheumatology, University of Toronto, Toronto; Department of Family Medicine, McMaster University, Hamilton, Ontario; Division of Rheumatology, Departments of Medicine and Pathology, Dalhousie University, Halifax, Nova Scotia, Canada.J. Widdifield, PhD, Department of Epidemiology, Biostatistics and Occupational Health, McGill University, and Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, and Institute for Clinical Evaluative Sciences; C.S. Moura, PhD, Department of Epidemiology, Biostatistics and Occupational Health, McGill University, and Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre; Y. Wang, PhD(c), Department of Epidemiology, Biostatistics and Occupational Health, McGill University; M. Abrahamowicz, PhD, Department of Epidemiology, Biostatistics and Occupational Health, McGill University; J.M. Paterson, MSc, Institute for Clinical Evaluative Sciences, and University of Toronto, Institute of Health Policy, Management and Evaluation, and Department of Family Medicine, McMaster University; A. Huang, MSc, Institute for Clinical Evaluative Sciences; M.E. Beauchamp, PhD, Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre; G. Boire, MD, FRCPC, MSc, Department of Medicine, Université de Sherbrooke; P.R. Fortin, MD, FRCPC, MPH, Division of Rheumatology, Department of Medic
| | - Anjie Huang
- From the Department of Epidemiology, Biostatistics and Occupational Health, McGill University; Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre; École de Réadaptation, Université de Montréal, Montreal; Department of Medicine, Université de Sherbrooke, Sherbrooke; Division of Rheumatology, Department of Medicine, Centre de recherche du CHU de Québec, Université Laval, Quebec City, Quebec; Institute for Clinical Evaluative Sciences, University of Toronto; Institute of Health Policy, Management and Evaluation; Division of Rheumatology, University of Toronto, Toronto; Department of Family Medicine, McMaster University, Hamilton, Ontario; Division of Rheumatology, Departments of Medicine and Pathology, Dalhousie University, Halifax, Nova Scotia, Canada.J. Widdifield, PhD, Department of Epidemiology, Biostatistics and Occupational Health, McGill University, and Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, and Institute for Clinical Evaluative Sciences; C.S. Moura, PhD, Department of Epidemiology, Biostatistics and Occupational Health, McGill University, and Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre; Y. Wang, PhD(c), Department of Epidemiology, Biostatistics and Occupational Health, McGill University; M. Abrahamowicz, PhD, Department of Epidemiology, Biostatistics and Occupational Health, McGill University; J.M. Paterson, MSc, Institute for Clinical Evaluative Sciences, and University of Toronto, Institute of Health Policy, Management and Evaluation, and Department of Family Medicine, McMaster University; A. Huang, MSc, Institute for Clinical Evaluative Sciences; M.E. Beauchamp, PhD, Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre; G. Boire, MD, FRCPC, MSc, Department of Medicine, Université de Sherbrooke; P.R. Fortin, MD, FRCPC, MPH, Division of Rheumatology, Department of Medic
| | - Marie-Eve Beauchamp
- From the Department of Epidemiology, Biostatistics and Occupational Health, McGill University; Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre; École de Réadaptation, Université de Montréal, Montreal; Department of Medicine, Université de Sherbrooke, Sherbrooke; Division of Rheumatology, Department of Medicine, Centre de recherche du CHU de Québec, Université Laval, Quebec City, Quebec; Institute for Clinical Evaluative Sciences, University of Toronto; Institute of Health Policy, Management and Evaluation; Division of Rheumatology, University of Toronto, Toronto; Department of Family Medicine, McMaster University, Hamilton, Ontario; Division of Rheumatology, Departments of Medicine and Pathology, Dalhousie University, Halifax, Nova Scotia, Canada.J. Widdifield, PhD, Department of Epidemiology, Biostatistics and Occupational Health, McGill University, and Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, and Institute for Clinical Evaluative Sciences; C.S. Moura, PhD, Department of Epidemiology, Biostatistics and Occupational Health, McGill University, and Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre; Y. Wang, PhD(c), Department of Epidemiology, Biostatistics and Occupational Health, McGill University; M. Abrahamowicz, PhD, Department of Epidemiology, Biostatistics and Occupational Health, McGill University; J.M. Paterson, MSc, Institute for Clinical Evaluative Sciences, and University of Toronto, Institute of Health Policy, Management and Evaluation, and Department of Family Medicine, McMaster University; A. Huang, MSc, Institute for Clinical Evaluative Sciences; M.E. Beauchamp, PhD, Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre; G. Boire, MD, FRCPC, MSc, Department of Medicine, Université de Sherbrooke; P.R. Fortin, MD, FRCPC, MPH, Division of Rheumatology, Department of Medic
| | - Gilles Boire
- From the Department of Epidemiology, Biostatistics and Occupational Health, McGill University; Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre; École de Réadaptation, Université de Montréal, Montreal; Department of Medicine, Université de Sherbrooke, Sherbrooke; Division of Rheumatology, Department of Medicine, Centre de recherche du CHU de Québec, Université Laval, Quebec City, Quebec; Institute for Clinical Evaluative Sciences, University of Toronto; Institute of Health Policy, Management and Evaluation; Division of Rheumatology, University of Toronto, Toronto; Department of Family Medicine, McMaster University, Hamilton, Ontario; Division of Rheumatology, Departments of Medicine and Pathology, Dalhousie University, Halifax, Nova Scotia, Canada.J. Widdifield, PhD, Department of Epidemiology, Biostatistics and Occupational Health, McGill University, and Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, and Institute for Clinical Evaluative Sciences; C.S. Moura, PhD, Department of Epidemiology, Biostatistics and Occupational Health, McGill University, and Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre; Y. Wang, PhD(c), Department of Epidemiology, Biostatistics and Occupational Health, McGill University; M. Abrahamowicz, PhD, Department of Epidemiology, Biostatistics and Occupational Health, McGill University; J.M. Paterson, MSc, Institute for Clinical Evaluative Sciences, and University of Toronto, Institute of Health Policy, Management and Evaluation, and Department of Family Medicine, McMaster University; A. Huang, MSc, Institute for Clinical Evaluative Sciences; M.E. Beauchamp, PhD, Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre; G. Boire, MD, FRCPC, MSc, Department of Medicine, Université de Sherbrooke; P.R. Fortin, MD, FRCPC, MPH, Division of Rheumatology, Department of Medic
| | - Paul R Fortin
- From the Department of Epidemiology, Biostatistics and Occupational Health, McGill University; Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre; École de Réadaptation, Université de Montréal, Montreal; Department of Medicine, Université de Sherbrooke, Sherbrooke; Division of Rheumatology, Department of Medicine, Centre de recherche du CHU de Québec, Université Laval, Quebec City, Quebec; Institute for Clinical Evaluative Sciences, University of Toronto; Institute of Health Policy, Management and Evaluation; Division of Rheumatology, University of Toronto, Toronto; Department of Family Medicine, McMaster University, Hamilton, Ontario; Division of Rheumatology, Departments of Medicine and Pathology, Dalhousie University, Halifax, Nova Scotia, Canada.J. Widdifield, PhD, Department of Epidemiology, Biostatistics and Occupational Health, McGill University, and Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, and Institute for Clinical Evaluative Sciences; C.S. Moura, PhD, Department of Epidemiology, Biostatistics and Occupational Health, McGill University, and Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre; Y. Wang, PhD(c), Department of Epidemiology, Biostatistics and Occupational Health, McGill University; M. Abrahamowicz, PhD, Department of Epidemiology, Biostatistics and Occupational Health, McGill University; J.M. Paterson, MSc, Institute for Clinical Evaluative Sciences, and University of Toronto, Institute of Health Policy, Management and Evaluation, and Department of Family Medicine, McMaster University; A. Huang, MSc, Institute for Clinical Evaluative Sciences; M.E. Beauchamp, PhD, Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre; G. Boire, MD, FRCPC, MSc, Department of Medicine, Université de Sherbrooke; P.R. Fortin, MD, FRCPC, MPH, Division of Rheumatology, Department of Medic
| | - Louis Bessette
- From the Department of Epidemiology, Biostatistics and Occupational Health, McGill University; Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre; École de Réadaptation, Université de Montréal, Montreal; Department of Medicine, Université de Sherbrooke, Sherbrooke; Division of Rheumatology, Department of Medicine, Centre de recherche du CHU de Québec, Université Laval, Quebec City, Quebec; Institute for Clinical Evaluative Sciences, University of Toronto; Institute of Health Policy, Management and Evaluation; Division of Rheumatology, University of Toronto, Toronto; Department of Family Medicine, McMaster University, Hamilton, Ontario; Division of Rheumatology, Departments of Medicine and Pathology, Dalhousie University, Halifax, Nova Scotia, Canada.J. Widdifield, PhD, Department of Epidemiology, Biostatistics and Occupational Health, McGill University, and Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, and Institute for Clinical Evaluative Sciences; C.S. Moura, PhD, Department of Epidemiology, Biostatistics and Occupational Health, McGill University, and Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre; Y. Wang, PhD(c), Department of Epidemiology, Biostatistics and Occupational Health, McGill University; M. Abrahamowicz, PhD, Department of Epidemiology, Biostatistics and Occupational Health, McGill University; J.M. Paterson, MSc, Institute for Clinical Evaluative Sciences, and University of Toronto, Institute of Health Policy, Management and Evaluation, and Department of Family Medicine, McMaster University; A. Huang, MSc, Institute for Clinical Evaluative Sciences; M.E. Beauchamp, PhD, Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre; G. Boire, MD, FRCPC, MSc, Department of Medicine, Université de Sherbrooke; P.R. Fortin, MD, FRCPC, MPH, Division of Rheumatology, Department of Medic
| | - Claire Bombardier
- From the Department of Epidemiology, Biostatistics and Occupational Health, McGill University; Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre; École de Réadaptation, Université de Montréal, Montreal; Department of Medicine, Université de Sherbrooke, Sherbrooke; Division of Rheumatology, Department of Medicine, Centre de recherche du CHU de Québec, Université Laval, Quebec City, Quebec; Institute for Clinical Evaluative Sciences, University of Toronto; Institute of Health Policy, Management and Evaluation; Division of Rheumatology, University of Toronto, Toronto; Department of Family Medicine, McMaster University, Hamilton, Ontario; Division of Rheumatology, Departments of Medicine and Pathology, Dalhousie University, Halifax, Nova Scotia, Canada.J. Widdifield, PhD, Department of Epidemiology, Biostatistics and Occupational Health, McGill University, and Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, and Institute for Clinical Evaluative Sciences; C.S. Moura, PhD, Department of Epidemiology, Biostatistics and Occupational Health, McGill University, and Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre; Y. Wang, PhD(c), Department of Epidemiology, Biostatistics and Occupational Health, McGill University; M. Abrahamowicz, PhD, Department of Epidemiology, Biostatistics and Occupational Health, McGill University; J.M. Paterson, MSc, Institute for Clinical Evaluative Sciences, and University of Toronto, Institute of Health Policy, Management and Evaluation, and Department of Family Medicine, McMaster University; A. Huang, MSc, Institute for Clinical Evaluative Sciences; M.E. Beauchamp, PhD, Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre; G. Boire, MD, FRCPC, MSc, Department of Medicine, Université de Sherbrooke; P.R. Fortin, MD, FRCPC, MPH, Division of Rheumatology, Department of Medic
| | - John G Hanly
- From the Department of Epidemiology, Biostatistics and Occupational Health, McGill University; Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre; École de Réadaptation, Université de Montréal, Montreal; Department of Medicine, Université de Sherbrooke, Sherbrooke; Division of Rheumatology, Department of Medicine, Centre de recherche du CHU de Québec, Université Laval, Quebec City, Quebec; Institute for Clinical Evaluative Sciences, University of Toronto; Institute of Health Policy, Management and Evaluation; Division of Rheumatology, University of Toronto, Toronto; Department of Family Medicine, McMaster University, Hamilton, Ontario; Division of Rheumatology, Departments of Medicine and Pathology, Dalhousie University, Halifax, Nova Scotia, Canada.J. Widdifield, PhD, Department of Epidemiology, Biostatistics and Occupational Health, McGill University, and Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, and Institute for Clinical Evaluative Sciences; C.S. Moura, PhD, Department of Epidemiology, Biostatistics and Occupational Health, McGill University, and Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre; Y. Wang, PhD(c), Department of Epidemiology, Biostatistics and Occupational Health, McGill University; M. Abrahamowicz, PhD, Department of Epidemiology, Biostatistics and Occupational Health, McGill University; J.M. Paterson, MSc, Institute for Clinical Evaluative Sciences, and University of Toronto, Institute of Health Policy, Management and Evaluation, and Department of Family Medicine, McMaster University; A. Huang, MSc, Institute for Clinical Evaluative Sciences; M.E. Beauchamp, PhD, Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre; G. Boire, MD, FRCPC, MSc, Department of Medicine, Université de Sherbrooke; P.R. Fortin, MD, FRCPC, MPH, Division of Rheumatology, Department of Medic
| | - Debbie Feldman
- From the Department of Epidemiology, Biostatistics and Occupational Health, McGill University; Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre; École de Réadaptation, Université de Montréal, Montreal; Department of Medicine, Université de Sherbrooke, Sherbrooke; Division of Rheumatology, Department of Medicine, Centre de recherche du CHU de Québec, Université Laval, Quebec City, Quebec; Institute for Clinical Evaluative Sciences, University of Toronto; Institute of Health Policy, Management and Evaluation; Division of Rheumatology, University of Toronto, Toronto; Department of Family Medicine, McMaster University, Hamilton, Ontario; Division of Rheumatology, Departments of Medicine and Pathology, Dalhousie University, Halifax, Nova Scotia, Canada.J. Widdifield, PhD, Department of Epidemiology, Biostatistics and Occupational Health, McGill University, and Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, and Institute for Clinical Evaluative Sciences; C.S. Moura, PhD, Department of Epidemiology, Biostatistics and Occupational Health, McGill University, and Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre; Y. Wang, PhD(c), Department of Epidemiology, Biostatistics and Occupational Health, McGill University; M. Abrahamowicz, PhD, Department of Epidemiology, Biostatistics and Occupational Health, McGill University; J.M. Paterson, MSc, Institute for Clinical Evaluative Sciences, and University of Toronto, Institute of Health Policy, Management and Evaluation, and Department of Family Medicine, McMaster University; A. Huang, MSc, Institute for Clinical Evaluative Sciences; M.E. Beauchamp, PhD, Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre; G. Boire, MD, FRCPC, MSc, Department of Medicine, Université de Sherbrooke; P.R. Fortin, MD, FRCPC, MPH, Division of Rheumatology, Department of Medic
| | - Sasha Bernatsky
- From the Department of Epidemiology, Biostatistics and Occupational Health, McGill University; Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre; École de Réadaptation, Université de Montréal, Montreal; Department of Medicine, Université de Sherbrooke, Sherbrooke; Division of Rheumatology, Department of Medicine, Centre de recherche du CHU de Québec, Université Laval, Quebec City, Quebec; Institute for Clinical Evaluative Sciences, University of Toronto; Institute of Health Policy, Management and Evaluation; Division of Rheumatology, University of Toronto, Toronto; Department of Family Medicine, McMaster University, Hamilton, Ontario; Division of Rheumatology, Departments of Medicine and Pathology, Dalhousie University, Halifax, Nova Scotia, Canada.J. Widdifield, PhD, Department of Epidemiology, Biostatistics and Occupational Health, McGill University, and Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, and Institute for Clinical Evaluative Sciences; C.S. Moura, PhD, Department of Epidemiology, Biostatistics and Occupational Health, McGill University, and Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre; Y. Wang, PhD(c), Department of Epidemiology, Biostatistics and Occupational Health, McGill University; M. Abrahamowicz, PhD, Department of Epidemiology, Biostatistics and Occupational Health, McGill University; J.M. Paterson, MSc, Institute for Clinical Evaluative Sciences, and University of Toronto, Institute of Health Policy, Management and Evaluation, and Department of Family Medicine, McMaster University; A. Huang, MSc, Institute for Clinical Evaluative Sciences; M.E. Beauchamp, PhD, Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre; G. Boire, MD, FRCPC, MSc, Department of Medicine, Université de Sherbrooke; P.R. Fortin, MD, FRCPC, MPH, Division of Rheumatology, Department of Medic
| | | |
Collapse
|
25
|
Widdifield J, Bernatsky S, Paterson JM, Tomlinson G, Tu K, Kuriya B, Thorne JC, Pope JE, Hollands S, Bombardier C. Trends in Excess Mortality Among Patients With Rheumatoid Arthritis in Ontario, Canada. Arthritis Care Res (Hoboken) 2015; 67:1047-53. [PMID: 25623141 DOI: 10.1002/acr.22553] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 08/08/2014] [Accepted: 01/20/2015] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To evaluate excess mortality over time, comparing rheumatoid arthritis (RA) patients with the general population. METHODS We computed all-cause mortality rates among Ontario residents age ≥15 years with RA versus without RA from 1996 to 2009. Age- and sex-standardized mortality rates were expressed as the number of deaths per 1,000 population. Excess mortality rates were calculated as the difference between death rates among RA patients and those in the general population. We estimated standardized mortality ratios (SMRs) and mortality rate ratios (MRRs) to assess relative excess mortality over time. RESULTS From 1996 to 2009, SMRs in RA ranged from 13.0 (95% confidence interval [95% CI] 12.2, 13.9) to 9.2 deaths per 1,000 RA patients (95% CI 8.4, 10.0); and for those without RA from 8.7 (95% CI 8.6, 8.7) to 6.0 deaths (95% CI 5.9, 6.0) per 1,000 general population. Over the study period, the excess mortality rate among RA patients was approximately 3 excess deaths per 1,000 population. Relative reductions in standardized mortality rates occurred over time for those with and without RA (-21.4% versus -13.4%). The SMRs for RA patients in 1996-1997, 2000-2001, 2004-2005, and 2008-2009 were 1.51 (95% CI 1.43, 1.59), 1.50 (95% CI 1.43, 1.57), 1.43 (95% CI 1.37, 1.50), and 1.41 (95% CI 1.35, 1.47), respectively. We did not find a significant change in the MRR by calendar time. CONCLUSION Mortality for RA patients has decreased over time but remains elevated compared to the general population, with 40-50% more deaths among RA patients. The relative excess mortality over time (mortality gap) remains unchanged in our sample.
Collapse
Affiliation(s)
- Jessica Widdifield
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, and McGill University, Montreal, Quebec, Canada
| | | | - J Michael Paterson
- Institute for Clinical Evaluative Sciences and University of Toronto, Toronto, Ontario, and McMaster University, Hamilton, Ontario, Canada
| | | | - Karen Tu
- Institute for Clinical Evaluative Sciences and University of Toronto, Toronto, Ontario, Canada
| | | | - J Carter Thorne
- Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | | | - Simon Hollands
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | | |
Collapse
|
26
|
Pelaez I, Infante C, Quintana R. Help-seeking trajectory in patients with rheumatoid arthritis. Clin Rheumatol 2015; 34 Suppl 1:S17-28. [PMID: 26198587 PMCID: PMC4617855 DOI: 10.1007/s10067-015-3013-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 04/10/2015] [Accepted: 05/17/2015] [Indexed: 10/25/2022]
Abstract
Early diagnosis and treatment of rheumatoid arthritis (RA) depends on the degree of fit between the characteristics of the patients and those of the health services. Ensuring timely assessment and treatment is the ideal medical care of RA. The reasons that underlay delays and the help-seeking trajectories are contextually determined. This study aims to identify the empirical evidence related to the help-seeking process and delay in RA in Latin America and to create a comprehensive model integrating the RA medical care processes of help-seeking and delay in a mixed health care system with variable accessibility. Non-systematic literature review of studies with both quantitative and qualitative methodology was conducted. Most of the research about delay and its associated variables have been undertaken in European countries and with White population and cannot be translated to the Latin America context where this research is almost inexistent. These countries have a completely different social context, and for most of the population, the health services are insufficient, inaccessible, fragmented, limited, and inequitable. Our results also show that in RA medical care utilization research, the theories and measurements of the constructs of illness trajectories, help-seeking, and accessibility are not integrated. We offer a conceptual framework that integrates help-seeking trajectories, delay, and accessibility of RA medical health services. If research on RA service utilization is to be undertaken in these countries, there is a need for a comprehensive framework than can enable researchers to integrate and contextualize the study of the problems within broad theoretical and methodological perspectives.
Collapse
Affiliation(s)
- Ingris Pelaez
- Rheumatology Service, General Hospital of Mexico, Mexico City, Mexico
| | - Claudia Infante
- Institute for Social Research, UNAM, National Autonomous University of Mexico, Circuito Mario de la Cueva S/N, Ciudad Universitaria, C.P. 04510, Mexico City, Mexico.
| | - Rosana Quintana
- Provincial Hospital of Rosario, Rosario, Santa Fe, Argentina
| |
Collapse
|
27
|
Al Maini M, Adelowo F, Al Saleh J, Al Weshahi Y, Burmester GR, Cutolo M, Flood J, March L, McDonald-Blumer H, Pile K, Pineda C, Thorne C, Kvien TK. The global challenges and opportunities in the practice of rheumatology: white paper by the World Forum on Rheumatic and Musculoskeletal Diseases. Clin Rheumatol 2014; 34:819-29. [PMID: 25501633 PMCID: PMC4408363 DOI: 10.1007/s10067-014-2841-6] [Citation(s) in RCA: 134] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 11/28/2014] [Accepted: 12/01/2014] [Indexed: 11/25/2022]
Abstract
Rheumatic and musculoskeletal diseases (RMDs) represent a multitude of degenerative, inflammatory and auto-immune conditions affecting millions of people worldwide. Persons with these diseases may potentially experience severe chronic pain, joint damage, increasing disability and even death. With an increasingly ageing population, the prevalence and burden of RMDs are predicted to increase, placing greater demands on the global practice of rheumatology and related healthcare budgets. Effective treatment of RMDs currently faces a number of challenges in both the developed and developing world, and individual countries may face more specific local challenges. However, limited understanding of the burden of RMDs amongst public health professionals and policy-makers means that these diseases are often not considered a public health priority. The objective of this review is to increase awareness of the RMDs and to identify opportunities to address RMD challenges on both a local and global scale. On 26 September 2014, rheumatology experts from five different continents met at the World Forum on Rheumatic and Musculoskeletal Diseases (WFRMD) to discuss and identify some key challenges for the RMDs community today. The outcomes are presented in this review, focusing on access to rheumatology services, diagnostics and therapies, rheumatology education and training and on clinical trials, as well as investigator-initiated and epidemiological research. The long-term vision of the WFRMD is to increase perception of the RMDs as a major burden to society and to explore potential opportunities to improve global and local RMD care.
Collapse
|